Objective.—To study work attendance despite headache in 2 different workplaces and its economic impact.

Background.—Literature on the economic impact of headache traditionally has focused on direct costs. Little is known concerning headache experienced at work and its costs due to loss of effectiveness and productivity.

Method.—We sent a questionnaire to 800 employees in Sweden—400 at a technology company (private employee population) and 400 at a university hospital (public employee population). We attempted to assess the prevalence of headache, work attendance despite the presence of acute headache, and the impact of acute headache upon work effectiveness. Subjects self-scored decreased work effectiveness resulting from headache during the previous 3 months and recorded the number of days at work despite headache. From these data, we estimated the economic loss resulting from headache.

Results.—The survey response rate was 71.5%. The prevalence of headache was 64% in the private employee population and 78% in the public employee population. Thirty-nine percent of the private employees and 57% of the public employees reported experiencing headache as a result of stress. Fifty percent reported that they went to work despite headache, and the mean number of days at work despite headache, during the previous 3 months, was 6.6 days in the private employee group and 6.1 days in the public employee group. A 25% decrease in work effectiveness was estimated, and, extrapolating from our data, we calculated the cost of lost effectiveness due to headache among employers in Sweden to be approximately 1.4 billion euros a year.

Conclusion.—The economic burden of headache experienced at work is substantial, suggesting that workplace-based treatment and prevention programs emphasizing stress management may be financially, as well as clinically, advantageous.